Page 223 - ATP-P 11th Ed

EAR INFECTION PROTOCOL
(INCLUDES OTITIS MEDIA AND OTITIS EXTERNA)

SPECIAL CONSIDERATIONS
1. Infection of the middle or external ear may be viral or bacterial in etiology.
2. Increased pressure in the middle ear may cause intense pain and may result in
rupture of the tympanic membrane (characterized by sudden decrease in pain
and drainage from ear canal).
SECTION 2
Signs and Symptoms
1. Otitis Media
a. Ear pain
b. Decreased hearing
c. Inflamed, bulging ear drum on otoscope exam
2. Otitis Externa
a. Ear canal drainage
b. Pain on motion of tragus (outer ear)
c. Cracked, red, inflamed external auditory canal
Management
1. Otitis Media
Moxifloxacin (Avelox ) 400mg PO daily for 10 days OR azithromycin (Zythro-
®
max ) Z-PAK 500mg PO initially followed by 250mg PO daily × 4 days
®
®
2. Otitis Externa
Gatifloxacin (Zymar ) drops, 5 drops tid – qid until symptoms remain resolved
®
for 48 hours
3. Treat per Pain Management Protocol.
4. If water immersion is anticipated, use earplugs to prevent cold water entry which
will cause vertigo.

Disposition
1. For uncomplicated cases, no evacuation is necessary.
2. Routine evacuation for complicated cases not responding to therapy.

212 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 213